Saturday, June 3, 2017

Serial killers in health-care settings can be hard to catch and hard to prosecute, but Yorker said some measures have been taken in the U.S. in recent years to prevent what Cullen, Wettlaufer and others were able to do. Administering medications is now frequently computerized, and hospitals are better at tracking what nurses are giving patients through a rigorous identification system.

The tragedy of this case is the checks and balances failed and the question now is why?
Why did the nursing teams not detect discrepancies in the nursing notes and medications at shift changes?
Why did facility pharmacists not question the medication reconciliations and the blood glucose results?
Why did not one single manager review the performance of the nurse and conclude that there was a performance problem that was detrimental to patient health and safety?
Where there any attempts made to mentor and solve the performance problems by the employers and the Nursing Association in Ontario?
What disciplinary actions -if any were taken for the problems?
What about the Government of Alberta audits of these facilities? Did they turn up medication reconciliation problems? If the audits did find problems what did the health authority do about these problems?
Many questions and so far no answers.
LikeShow more reactions

In my opinion, accurate medication records and reconciliation would have resulted in the discovery of problems in medication use at facilities where Elizabeth Wettlaufer worked.
So why did these facilities not detect the problems in medication dispensation and reconciliation?
What went wrong with the reviews by the pharmacists at these sites?
And why were these problems in medication use not detected by the auditing of these facilities?
These questions require answers and even a public inquiry because if outdated medication dispensing protocols allowed for this sort of lax control of medications well then there may be other Elizabeth Wettlaufers in the system.

After ex-nurse Elizabeth Wettlaufer admitted to killing eight patients, she's now toward the top Canada's list of most-deadly serial killers. But she has gained an…

Health-care killers 'statistically rare' but difficult to spot

Elizabeth Wettlaufer is now one of Canada's most-deadly serial killers after pleading guilty to 8 murders

By Meagan Fitzpatrick, CBC News Posted: Jun 03, 2017 5:00 AM ET Last Updated: Jun 03, 2017 10:32 AM ET
Elizabeth Wettlaufer is escorted into the courthouse in Woodstock, Ont., on Thursday. The former nurse has pleaded guilty to killing eight patients under her care, making her Canada's first convicted health-care killer.
Elizabeth Wettlaufer is escorted into the courthouse in Woodstock, Ont., on Thursday. The former nurse has pleaded guilty to killing eight patients under her care, making her Canada's first convicted health-care killer. (Peter Power/Canadian Press)







Photo of Meagan Fitzpatrick
Meagan Fitzpatrick
Meagan Fitzpatrick is a multi-platform reporter with CBC in Toronto. Before returning to her hometown she worked in CBC's Washington bureau for several years, including 2016, which meant covering the historic presidential election. Prior to heading south of the border Meagan worked in CBC's Parliament Hill bureau. She has also reported for CBC from Hong Kong.

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Elizabeth Wettlaufer, the ex-nurse who confessed this week to murdering eight elderly patients in her care, is now near the top of the list of Canada's serial killers — and it's her profession that gives her even more notoriety.
Other Canadian killers have killed more victims: Robert Pickton, for example, confessed to killing 49 women, and Clifford Olson was convicted of 11 murders, largely children.
But after Wettlaufer pleaded guilty Thursday to eight counts of first-degree murder, four counts of attempted murder and two counts of aggravated assault, she became the first convicted serial killer in the history of Canada's health-care system.
Wettlaufer — who administered lethal doses of insulin to victims at two Ontario nursing homes over the course of seven years — is now also among a roster of nurses from around the world who carried out their crimes at work.
Health-care workers who kill are "statistically rare," says Michael Arntfield, an assistant professor at Western University. But when they do, they tend to kill a lot of people before they're stopped.
"It is not entirely surprising that in Canada, our first known health-care serial killer is so prolific," he said, adding that in a field dealing with life and death, these kinds of killers can often go undetected.
Wettlaufer Niagara Falls
Wettlaufer often worked as the nurse in charge on the night shift at long-term care homes in the southern Ontario cities of Woodstock, Paris and London. (Facebook)
In the United States, the most prolific health-care killer is Charles Cullen, a critical care nurse who admitted to killing 40 patients in New Jersey and Pennsylvania during his 16-year career. Case experts suspect it's possible that he could have caused more than 300 deaths.
And Italian nurse Daniela Poggiali is currently in jail, awaiting trial in connection to the deaths of at least 38 patients. Police in that country believe she could be responsible for the deaths of as many as 96 patients; she is accused of poisoning them with potassium chloride and taking selfies with some of the bodies.
In Germany, a former nurse known only as Niels H confessed to killing more than 30 patients, though he was only convicted in two deaths. His trial heard he intentionally brought about cardiac crises in about 90 patients because he liked the feeling of being able to resuscitate them.

'Daily access to victims'

"Health-care serial killers frequently have the highest body count of all serial killers because they have daily access to victims," says Arntfield, who recently wrote a book on serial killers called Murder in Plain English.
Beatrice Yorker, of California State University, has also studied serial killers in the health-care field. She's examined dozens of cases where nurses were prosecuted and says Wettlaufer fits the pattern of many health-care killers.
"She fits the long-term care nursing home profile, which is power, control and an extra-heavy workload — feeling a little sadistic toward the patients," said Yorker.
PlayPoster of video clip
Elizabeth Wettlaufer describes how she killed a patient
00:00 00:34
Elizabeth Wettlaufer describes how she killed a patient0:34
In a taped confession to police that was played in court, Wettlaufer offered various explanations for her actions. At one point, she said she believed that either God or the devil wanted her to kill these people. At other points, she said she was visited by "surges" that she could not control.
Wettlaufer also told police she picked some of her victims because they "were mean," difficult to look after and that she had a heavy workload.
Killers like Wettlaufer are looking to exert power they don't have in their own lives, Arntfield said, and "select patients that essentially just annoy them."

Killers hard to detect

Some are believed to be motivated by what's called the "angel of death syndrome" or the "Mother Theresa syndrome," where the killers claim they were doing patients a favour and showing mercy by ending their lives.  
Others may crave attention, and will carry out the lethal act, only to then attempt to save the patient so they can get credit for it.
Charles Cullen is a former critical care nurse who admitted to killing 40 patients in New Jersey and Pennsylvania during his 16-year career. (Mike Derer/Associated Press)
Both Arntfield and Yorker say nursing homes are ideal environments for serial killers: They have constant access to potential victims, legal access to drugs, there are often no witnesses and the deaths may not be considered suspicious, given the patients are ill and elderly, meaning autopsies are unlikely.
If there are suspicions, they are often expressed too late — after bodies have decomposed, or been cremated or embalmed, when chemical traces can't be detected.

'Canary in a coal mine'

"What we see in cases like Wettlaufer's is that it reveals to us just … what a blind spot in the system health care could be for a motivated offender who wants to exploit that access to vulnerable people," said Arntfield.
Serial killers in health-care settings can be hard to catch and hard to prosecute, but Yorker said some measures have been taken in the U.S. in recent years to prevent what Cullen, Wettlaufer and others were able to do.
Administering medications is now frequently computerized, and hospitals are better at tracking what nurses are giving patients through a rigorous identification system.
"There are a lot of safeguards in place to deter people," she says. "It's not nearly as easy as it used to be to get away with this."
But, she says, it still happens — and misuse of medication isn't always the method. In a recent U.S. case, a nurse was convicted of killing five patients after putting bleach in their dialysis tubes.
Meanwhile, the Wettlaufer case has prompted calls for a public inquiry to examine what went wrong and how to prevent it from happening again. It's an idea that Arntfield supports.
"This case, to me, is the canary in the coal mine that warns of other potential dangers in the system," he says. "And it needs to be addressed."

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    Julie Ali
    Julie Ali
    • Julie Ali
    The Elizabeth Wettlaufer case raises important questions about the reconciliation of medications at the facilities where she worked. Medication use is supposed to be strictly controlled and yet we have this nurse using medication as if it were easily obtainable without physician order.

    So what was going on in these facilities? Audits by the Government of Ontario should have detected these deviations from medication use and best practices.

    Why didn't the employers find these problems through their pharmacist reviews of medical files of each resident?

    So many problems seem to be associated with this case with reference to medication dispensation that I wonder if this area of nursing practice in continuing care needs a public inquiry to determine exactly where the system failed so that no other cases of misuse of medications can occur.« less
    • 24 minutes ago
    John Langton
    • John Langton
    As a regular patient in hospital I can say that there should be video surveillance in every room.

    This isn't the forum to say anything more on this subject other than my above statement is warranted.
    • 49 minutes ago
    William Burnham
    • William Burnham
    Health care killers are hard to identify, but we shouldn't discriminate against them or assume they have an aggressive ideology. I am sure our thorough vetting processes will find them all.
    • 50 minutes ago
    George Brant
    • George Brant
    Why did this not get reported to authorities when she revealed what she had done! Some would call this complicity.
    • 2 hours ago
    John Brown
    • John Brown
    The absolute twisted fact about this particular case is the demon actually told others, possibly tried to confess, maybe in an attempt to stop herself, and none of them reported it.

    That said, evil doings disguised as unfortunate but not unexpected like this can slide by. Better screening might help, but this is something that can and will happen again.

    You can't fix crazy, especially when it's well hidden.
    • 2 hours ago
    Rose Webster
    • Rose Webster
    @John Brown

    Agree "the demon actually told others, possibly tried to confess, maybe in an attempt to stop herself, and none of them reported it" ... didn't ANYONE see fit to file a complaint?
    • 2 hours ago
    Julie Ali
    • Julie Ali
    @Rose Webster Even if you file complaints advocates face retribution in Alberta. The system is not geared to identification of problems; it's geared to silencing advocates who spot non-compliances.

    In this case, what were the employers and the auditing bodies doing about the medication problems? Medication use is reviewed and reconciliation is required so why didn't the use of drugs by this nurse raise concerns?
    • 37 minutes ago
    Rex Yuan
    • Rex Yuan
    The Wettlaufer case sends a strong message to family members whose loved ones are in long term care facilities that they must be more involved (i.e. frequent visits) in order to identify unusual changes and decide on whether or not hospitalization (more professional staff and access to more medical services) is the right option. Please visit B.C. Seniors Advocate's website and be alert that a report from a major survey over the next 3 months. Findings are likely applicable to long term care facilities across Canada.« less
    • 9 hours ago
    Julie Ali
    • Julie Ali
    @Rex Yuan I doubt that any of the provincial governments will do anything about any report about abuse, death and neglect in continuing care facilities no matter how much evidence is presented to them of problems.

    Government is the problem. There are problems in funding where we don't know how much money goes to servicing residents who are actually patients in long term care facilities. Government in Alberta does not stipulate the staff:resident ratios. There is no interest in auditing or providing oversight of any worth unless of course media is involved. Why else would an AHS run facility in Lacombe be found to have many non-compliances to the standards of care upon complaints by nursing students at this facility?

    It just goes on and on. We have no penalties for providers who are non-compliant, there is no public information provided to the public of audits other than accommodation audits where for example the Lacombe facility was non-compliant over four years. It makes you wonder what the heck AHS and Alberta Health do in terms of assessment of performance of the providers. It's a chaotic business and we have decades of data in Alberta about the problems without any appreciable changes in the system. What's clear to families is that when we are on the scene and involved in the care of our family members (advocacy) there exists the risk of retribution. The Trespass to Premises Legislation is used to ban advocates as in the recent case of the Tucker family of Grande Prairie. There is no appeal for the bannings. In addition retribution against advocates includes legal actin by continuing care facilities (see Ruth Adria of Elder Advocates of Alberta Society) and mass firings of staff as in the recent case of the Points West Living Cold Lake workers.« less
    • 29 minutes ago
    Hugh MacDonald
    • Hugh MacDonald
    It's more than a "blind spot" in the system.
    There is such a demand for nurses and other health care personnel in this country that health care providers e.g. hospitals and nursing homes have turned a "blind eye" to checking the qualifications and backgrounds of the people they hire to provide patient care.
    And once they are hired, there is very little or any monitoring at all of their work, allowing an individual like Wettlaufer to carry out killings undetected for a extended period of time.
    • 9 hours ago
    Julie Ali
    • Julie Ali
    @Hugh MacDonald I agree with you. There are also problems in staff training that are not corrected until there are problems and even then there is resistance. Government in Alberta fails in oversight and ensuring compliance to the standards of care.

    We're tired of hearing successive health ministers tell us that abuse won't be tolerated when we hear in the media of ongoing problems of compliance that seem to persist for years without any fuss by AHS as in the recent exposure of many non-compliances at the Lacombe long term care facility which is run by the health authority.

    How is it even possible for AHS to not be aware of non-compliances at a facility it runs? When problems were found at this facility staff were put on leave but really why are we having oversight and monitoring after the fact of problems found out by nursing students at the sight?

    What exactly are managers, auditors and health authority executive staff paid to do?« less
    • 20 minutes ago
    Henry Cunha
    • Henry Cunha
    If it's not easy to spot, it's difficult to say how rare it is.
    • 9 hours ago
    Walter Plinge
    • Walter Plinge
    @Henry Cunha

    I don't think it's hard to spot....she didn't work alone would be near impossible to critique her practice

    I'm a heterosexual male ex-military medic with a BMI under 23

    30 years of working in the health care system...if I was to say one word about the competence of a person like this and I'd end up in HR explaining my

    body shamming


    to a HR manager who looks much more like her...than me

    the health-care system doesn't exist to provide care to exists to provide people (like this woman) with a place to "feel engaged and respected" just "be the grey man" your eight and hit the gate

    but...back in the day...where I learned my trade...she'd of lasted about 30 min before someone "kicked her flabby butt so far down the road that JC himself couldn't find her with a telescope"

    of couldn't do that today...people have "feelings"« less
    • 7 hours ago
    Glen Acanthus
    • Glen Acanthus
    So, a pastor say's 'If you ever do this again, we'll turn you in,'.....what? He should be charged as well.
    • 10 hours ago
    Jane Smith
    • Jane Smith
    Everyone who hired her is partly responsible for these deaths. I've had more rigorous vetting for jobs with far less responsibility.
    • 10 hours ago
    Phil Bigeau
    • Phil Bigeau
    her pastor told her not to do it again her lawyer told her to be quiet she not the only guilty one
    • 10 hours ago
    Gary McCaig
    • Gary McCaig
    While it may have been difficult to label her a killer it seems her incompetence and other work problems were well recognized by her employers but they chose to ignore this.
    • 11 hours ago
    Rose Webster
    • Rose Webster
    @Gary McCaig

    Good point. And it appears that no one complained to the College of Nurses.

    In the very least, her well-documented history of medication errors should have prompted a suspension on her ability to administer medications alone.

    And, a recommendation should have been made that she complete additional courses and pass competency testing in "Dosages and Solutions" (what it was called when I studied nursing).
    • 10 hours ago
    Roger Drisdelle
    • Roger Drisdelle
    Having worked security in a hospital, i found that another thing that is hard to detect is nurses stealing patient medication for personal use. I recall a few times we found a nurse ODing in a bathroom. They do everything to hide it from the public as well.
    • 11 hours ago
    R. Gabrielle Berry
    • R. Gabrielle Berry
    From the article: "Meanwhile, the Wettlaufer case has prompted calls for a public inquiry to examine what went wrong and how to prevent it from happening again. It's an idea that Arntfield supports...." And so do I.
    If you browse the topic e.g."google", you can spot common patterns.
    1. Several of the killers have claimed to be "angels of death”, but I find this highly questionable because any angel would know that God is in charge of life and death, or at least the person (who under legal requirements) chooses to die.
    2. Poor self-esteem attention seekers - attention comes from death, or worse, causing the dying process and then taking charge of the resuscitation.
    Richard Angelo, a nurse convicted of killing 10 patients in New York in the 1980s, said he injected drugs that gave patients cardiac arrests because he liked being treated as a hero when he tried, often unsuccessfully, to revive them.
    3. The revolving-door nurse or caregiver - There is so much pressure to keep long-term care facilities fully-staffed that employers sometimes don't carefully check references e.g. If a caregiver has had 10 jobs in 20 months, it should signal a need to be extremely cautious.
    Conclusion: However, the biggest sorrow I have regarding this phenomenon is the way in which our society has come to treat the elderly; that is, the very status which we assign to them - bothersome, frail, little value, disposable, in the way, nothing to give...taking up space. I ask myself: Could this happen in a society that revered its elderly and treated them accordingly?« less
    • 11 hours ago
    Rose Webster
    • Rose Webster
    A pastor and his wife "prayed over Elizabeth Wettlaufer and told her not to kill again ... but if you ever do this again we will have to turn you in to the police."

    A lawyer advised the registered nurse to take her murderous secrets to her grave.

    According to her police confession, she told a former girlfriend that she had killed two people already. The woman threatened to report the incidents if Wettlaufer killed again, she said.

    What is wrong with these four people?

    I would report the... » more
    • 11 hours ago
    Joen Conner
    • Joen Conner
    @Rose Webster

    Well most people don't even help others that have died on park bench thru the night . Does not surprise me.
    • 11 hours ago
    Fée Lotus
    • Fée Lotus
    @Rose Webster
     Please: Legally, will those four people be prosecuted? I just don’t know.
    • 11 hours ago
    Rose Webster
    • Rose Webster
    @Fée Lotus

    If someone tells his/her attorney "I am guilty of .......," a lawyer cannot ethically argue that the person is innocent.

    As far as I know, an attorney cannot lie, and cannot encourage any witnesses to lie.

    I don't know if legally all four can be prosecuted for keeping her first murders a secret.

    But it's shocking (to me) that at least four people would "brush off" something so heinous.
    • 11 hours ago
    Joen Conner
    • Joen Conner
    I want to know who her victims were. Were they majority male?
    • 11 hours ago
    Joen Conner
    • Joen Conner
    Could it be at all possible that some of the reason there is so many opiate deaths is because of a serial killer that is either mixing the drugs or directly injecting people? How come the death toll is so high in Vancouver. Why is it over 80% of men could it be a female targeting men?
    • 11 hours ago
    Norm Duck
    • Norm Duck
    Their is only one place left for this woman ,6 feet under People like her do not deserve a second chance .
    • 12 hours ago
    Pat Chabot
    • Pat Chabot
    The amazing thing is, so many people knew and did nothing.
    • 12 hours ago
    Julie Ali
    • Julie Ali
    @Pat Chabot People are afraid to speak about problems in continuing care. In Alberta there is retribution including eviction, banning, lawsuits.
    Ruth Adria of the Elder Advocates of Alberta Society has been documenting abuse cases of seniors and retribution by providers against families.

    The PCs put in a Trespass to Premises Legislation which has no appeal. You can be separated from the family member in care by banning and there is no way to appeal this business. I believe this is a human rights abuse.

    There are no resident rights to enshrine visitation and so the abused resident may be separated from the family advocate. Folks who do complain generally shut up after a cease and desist letter warning them to silence.« less
    • 14 minutes ago
    Joen Conner
    • Joen Conner
    A teenage girl from Chicago who has been charged with killing an Uber driver randomly attacked the man with a knife and a machete that she had just stolen from Walmart, authorities say.
    • 12 hours ago
    Colleen Goodrich
    • Colleen Goodrich
    @Joen Conner , you're 'way off topic. Try reading the article first.
    • 11 hours ago
    Joen Conner
    • Joen Conner
    @Colleen Goodrich

    it's not a topic just news that's not reported at cbc
    • 9 hours ago
    Joan Wagman
    • Joan Wagman
    @Joen Conner
     Chicago is not in Canada, for starters.... I am more concerned with a Canadian nurse who took the lives of many patients under her care than American random violence.
    • 8 hours ago
    Richard Nichols
    • Richard Nichols
    @Joen Conner

    How many murders in a single day in the USA....that is more relevant.
    • 8 hours ago
    Peter MacDonald
    • Peter MacDonald
    One of the largest killers is the retirement homes themselves. I have only been in a few, but about half of the seniors in each were just sitting there or aimlessly shuffling, blankly staring for hours with no stimulation whatsoever. I can think of no method better than withdrawal of all contact and instilling a sense of hopelessness to shorten someone's live. It's mass murder.
    • 12 hours ago
    R. Gabrielle Berry
    • R. Gabrielle Berry
    @Peter MacDonald
     I too have had cause to "tour" several long-term care facilities. The only objection that I have to what you have written is that MORE THAN HALF
    of the "Residents" fall into the category of no stimulation or psychological/emotional neglect.
    If you speak to some of these Residents, you will find that it's not uncommon for them to complain about lack of timely/quality care (including personal hygiene). Some will tell you that they would rather die than go on living where they are... » more
    • 11 hours ago
    Julie Ali
    • Julie Ali
    @Peter MacDonald I have to agree with you that those in the continuing care system are our most defenceless and lonely citizens.
    Some of them have no quality of life.
    It's very troubling.

    What's even worse is that folks like Ruth Adria who advocates for these folks faces retribution for her work. Ruth Adria has been given banning tickets and escorted off the premises by security staff. Her work as an elder advocate has been impeded by the continuing care industry itself and the health care... » more
    • 9 minutes ago
    Pete Lindsay
    • Pete Lindsay
    Her pastor tells her if you kill "again" I will turn you in???????how about the Pastor turn her in right away....her lawyer tells her to go to her grave telling no one about her crimes, wow, what about telling her to go to the police and admit your crime

    Sounds like she's not the only monster in this story
    • 12 hours ago
    marianne stevens
    • marianne stevens
    If there had been a nursing team in place at this understaffed, poorly administered Long Term Care Home, Wettlaufer's clearly deranged thinking would have been observed by any logical minded, professional nurse. If there had been supervision to whom reporting concerns were made possible & available, she could have been investigated. The fault lies in the substandard care given to elders in private enterprises interested primarily in profit. The Gov't plays along, shuffling their responsibilities for quality health care to the private sector.« less
    • 12 hours ago
    Julie Ali
    • Julie Ali
    @marianne stevens I agree with you. Managers at facilities have to control expenses. Staff:resident ratios are abysmal. Training is sometimes lacking. Both private and public facilities in Alberta have problems and the GOA is missing in action.

    Complaints by families have to reach a threshold level before anything is done. Media attention seems to be the prerequisite before the government of Alberta does anything; then we have the same response by the folks at AHS that they take these... » more
    • 5 minutes ago
    Wade Turcotte
    • Wade Turcotte
    Nursing is a 24/7/365 job and no one else saw anything??? I would have caught this person in a day.
    • 13 hours ago
    Wade Turcotte
    • Wade Turcotte
    The story says, "Wettlaufer — who administered lethal doses of insulin to victims. "wettlaufer worked with other nurse other care workers and is person telling me that NOT ONE of these OTHER staff members caring for the SAME patients could recognize severe hypoglycemia??? The A1C bloodwork, the friggin blood glucose records??? were they also fabricated??/
    Are you saying the other nurses/pharmacists working there couldn't notice the rapid use of multidose vials or pens????

    Nursing is a 24/7/365 job and no one else saw anything??? I would have caught this person in a day.« less
    • 13 hours ago
    Julie Ali
    • Julie Ali
    @Wade Turcotte The pharmacists at these sites should have detected the medication reconciliation problems.So why didn't they?

    What about the government of Ontario auditing bodies?

    What about the nurses who worked with her? Usually you have a nurse (RN) and other LPNs in Alberta working as a team. Did these teams not go over the nursing notes as required at shift change? As you mention what about the glucose blood work? It's mind boggling.
    • 2 minutes ago
    Terry Blume
    • Terry Blume
    I think it is the Canary in the Coal Mine scenario !!

    Long term care is understaffed relative to resident care needs to a large extent. So many front liners suffer from anxiety, given their mandate and the inability to accomplish due to inadequate funding and resources. The basic needs of residents are often not met due to time constraints which are incredibly stressful to nursing staff. All of which leads to burnout. Why do the Seniors have less benefits than convicted criminals re food allotments, briefs etc. ? The system is clearly underfunded and over looked . It seems that Long Term Care is not a priority to the ministry. The European model for staffing ratio's proves it can be accomplished and goals achieved with proper staffing 7/24/365. Time for a total inquiry and some hard answers to be implemented !« less
    • 13 hours ago
    Pete Lindsay
    • Pete Lindsay
    @Terry Blume why do seniors get less than criminals because someone decided to vote for Justin
    • 12 hours ago
    Terry Blume
    • Terry Blume
    @Pete Lindsay The Issue needs to be addressed at all levels of health care funding ! Front lines need more, far more support period from all levels including the actual nursing staff supporting each other. When the staff is burnt out, finger pointing is the result and that benefits absolutely NO one ! We are all getting older and if it isn't seen to now what will be your own future is my question ???
    • 11 hours ago
    Julie Ali
    • Julie Ali
    @Pete Lindsay Continuing care is a provincial responsibility and Mr. Trudeau has nothing to do with the problems in funding. This is entirely the fault of the provincial governments.

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